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Background. The range of motion prior to total knee arthroplasty (TKA) is a key determinant of the postoperative range of motion. The chance that the accompanying stiffness of the extensor mechanism may lead to limited flexion following surgery increases with how restricted the preoperative range of motion was. It would make sense to enhance knee ROM before surgery in order to optimize flexion following TKA. Final flexion following TKA is affected by a number of factors, although preoperative range of motion is the most important. The aim of the study to evaluate the functional performance and efficacy of the preoperative exercise programme on the osteoarthritic knee during the exercise period, following arthroplasty, during immediate postoperative recovery, and at 1, 3, 6 and 12 months after surgery. Methods. For the study, 156 patients with knee arthritis were collected over a period of one and a half years. In this prospective study, they were divided into a treatment group and a control group. Preoperative knee exercise was given to 78 patients for at least one month. Prior to and following the treatment groups workouts, all patients were observed. The time in days before reaching 90 of knee flexion and the length of the hospital stay were the data that were gathered. At 4 weeks, 3 months, 6 months, and 1 year, each subject had their knee ROM and KSS reevaluated. Results. Knee workouts were unquestionably helpful in achieving early knee flexion up to 90 in comparison to that of the control group. When the treatment group was compared to the control group, knee flexion to about 90 and more was attained in about 4 weeks; this difference was statistically significant (p0.01). However, there were no appreciable variations in the knee range of motion achieved on long-term follow-up for 6 months and a year. Conclusion. In conclusion, prehabilitation significantly improves the KSS for the treatment group both before surgery and three months after surgery. Exercises done before to surgery help patients recover more quickly from TKA and may speed up the process of achieving a good flexion and extension range of motion. However there is no significant difference in functional outcome after one year post surgery in both groups.

Lentil is an important winter food legume crop component of farming and food systems, contributing significantly on food and nutrition security, soil health and livelihood improvement of rural and marginal farmers of Nepal. Because of diverse benefits and increasing population, demand of lentil is escalating while production is decreasing. With the objective to investigate potential production, marketing and trade factors resulting wide gap between import and export of lentil, this study thoroughly analyze the global and national level, trader level and household level scenario of lentil production and trade in Nepal. Secondary data from secondary sources were used to critically examine the trend of lentil production and trade at the global and national level while primary data collected through household survey, Focus Group Discussion (FGD) and Key Informants Interviews (KII) with lentil producing, marketing and trading actors were used to investigate the present scenario along with possible opportunities and existing challenges. This study revealed that, globally, area under lentil cultivation and production are decreasing since 2017 while productivity of lentil is increasing. In Nepal, lentil had shared almost 5% of global area and almost 4.7% of global production in between 2011 to 2014 while the contribution is slightly decreased and reached to 4.24% and 4.02% in 2020. Up to the year 2013, export quantity of Nepalese lentil was higher that import quantity but after 2013, import quantity has always exceeded the export quantity. In the year 2020, import quantity of lentil was almost 24 times higher than export quantity. Milling quantity of Nepalese lentil is decreasing year after years and some large millers of Nepal has shifted their milling industry towards the other legumes because of quantity constraints. At the farmer’s levels, production of lentil is also dwindling year after years. Biotic and abiotic threats especially erratic and heavy rainfall at the time of pre-flowering and flowering stage, prevalence of Stemphylium Blight and root rot disease along with the persistence of low input use and insect/pest in lentil cultivation has caused the drastic yield loss in lentil. Existing extension and development programs of lentil formulated and implemented by government are not sufficient to increases the production. Decreased production in recent years has reversed the trade scenario of lentil from top exportable to the most importable legume. Effective government policies and programs along with the technology development from public and private side is the most needed condition to uplift the lentil sector in Nepal.

As one of the largest contributors of morbidity and mortality, psychiatric disorders are anticipated to triple in prevalence over the coming decade or so. Major obstacles to psychiatric care include stigma, funding constraints, and a dearth of resources and psychiatrists. The main thrust of our present-day discussion has been towards the direction of how machine learning and artificial intelligence could influence the way that patients experience care. To better grasp the issues regarding trust, privacy, and autonomy, their societal and ethical ramifications need to be probed. There is always the possibility that the artificial mind could malfunction or exhibit behavioral abnormalities. An in-depth philosophical understanding of these possibilities in both human and artificial intelligence could offer correlational insights into the robotic management of mental disorders in the future. This article looks into the role of artificial intelligence, the different challenges associated with it, as well as the perspectives in the management of such mental illnesses as depression, anxiety, and schizophrenia.

Background. Osteoporosis is a common metabolic disorder characterised by decreased bone mass and weakened micro-architecture of bone tissue. After 50 years of age, one in three women and one in five men experience osteoporotic fractures. This is projected to cause a yearly loss of 5.8 million healthy life years to disability. The number of patients who attend the outpatient clinic and emergency department of Sanjay Gandhi Institute of Trauma and Orthopaedics with fragility fractures has been increasing, hence to know the prevalence of osteoporosis in the general population who were asymptomatic, we decided to conduct a study in the rural areas of south India. Aims: 1) to estimate the prevalence of osteoporosis among the population above 50 years in rural areas of south India; 2) to determine the correlation between common secondary risk factors for osteoporosis like tobacco consumption, alcohol, diabetes, and hypertension. Results. The prevalence of osteoporosis in the rural population was more in females at 42.2%, whereas the males had a prevalence of 32.5%. Among the population with habits of tobacco consumption and alcohol consumption, the prevalence was 78% and 30.6% respectively. 20.2% of non-smokers and 39.7% of non-alcoholics were osteoporotic. Among the population with comorbidities, 53.6% of diabetes and 55.4% of hypertensives were osteoporotic. 33.7% of non-diabetics were osteoporotic, and 29.5% of hypertensives were osteoporotic. The correlation between osteoporosis and the individual risk factors ranged between weak negative to moderately positive (r = -0.2 to 0.5). The correlation between the combination of all the four risk factors and osteoporosis is weakly positive (r = 0.339), which is highly significant (p0.001). Conclusion. Overall, the findings of this study suggest that addictive habits such as tobacco and alcohol consumption may have a significant impact on bone health, with a higher prevalence of osteopenia and osteoporosis observed in individuals with these habits. Comorbidities such as diabetes and hypertension were also found to be associated with a higher prevalence of osteoporosis. These findings emphasize the importance of early detection and prevention of addictive habits and comorbidities to reduce the risk of osteopenia and osteoporosis. Furthermore, the study highlights the need for further research to fully understand the complex relationships between sociodemographic factors, addictive habits, comorbidities, and bone health.

Corrective osteotomy for cubitus varus deformity can be approached both via triceps splitting approach as well as paratricipital approach. The aim of our study was to compare the functional outcome after triceps splitting and paratricepetal approach for corrective osteotomy in cubitus Varus deformities. None of the previous studies have compared the approaches head to head when dealing with osteotomy for cubitus varus deformities. This is a retrospective study done on cases operated between January 2001 and December 2015. A total of 40 patients presented with cubitus varus deformity. Exclusion criteria removed 10 patients from the study. Of the 40 patients, 22 patients had been operated with a triceps splitting approach while 18 patients had been operated with a paratricepetal approach. In all the cases stabilization was done using internal fixation. Postoperative immobilization consisted of above elbow slabs or cast for a duration of three weeks. The length of duration for which follow up was available for all the cases was two years. Retrospectively data was extracted. Morrey’s system of functional assessment of outcome had been primarily used by the surgeons to assess the outcomes. Other than this, an osteotomy that corrected the humeral – ulnar angle to less than 10 degrees of the contralateral side was considered a good result. Our final data consisted of 40 cases. All the twenty-two cases in group A were fully satisfied with cosmetic results, but one case in group B had complaints related to cosmetic appearance due to excessive lateral condylar prominence. In group A, there was no pain in seventeen, mild pain in three, moderate pain in two cases and none had severe pain. In group B, there was no pain in fifteen, mild pain in two, moderate pain in one case and none had severe pain. No case had instability in the coronal plane. Till date, neither triceps-splitting nor paratricepetal approach is considered superior to the other approach. Mostly, the experience of the surgeon and the type of fracture determine the preferred incision to be employed. As compared to triceps splitting approach, paratricepetal approach results in better functional outcomes, triceps strength, elbow ROM and less extension contracture in the final follow up.

The paper considers a daylight transport system model with light pipes, which provides the illumination of building production areas with natural daylight. The presence of natural light generates considerable physiological effect and affects the energy consumption in a building. The paper discusses correct application of a daylight pipe system based on the use of natural free energy sunlight sources. The advantage of a vertical light pipe application is that the daylight is delivered to the given space. The light pipe system is an effective method of daylight improvement in the existing buildings. The paper presents approaches to illumination modeling using light pipes for achievement of the desired lighting result. Practical examples of modeling for different types of light tubes are given.

2020 ESC Guidelines for themanagement of adult congenital heart disease

Metal ions play vital roles in enzymes. They may also show sensitivity to various sulfhydryl reagents and chelating reagents. Effect of some metal ions, EDTA and sulfhydryl reagents on the activity of partially purified β-amylase of radish root were studied. Amylolytic activity of purified enzyme was increased substantially in the presence of Ca2+, Mg2+, and Zn2+. Some other divalent cations Cu2+, Pb2+, Sn2+, and Hg2+ almost completely ceased the enzyme activity. Cobalt (II), Manganese (II), and Iron (III) exhibited moderate activating effects on the activity. Of the monovalent cations, Na+ and Ag+ reduced the β-amylase activity, while K+ increased. The chelating agent EDTA was found to be effective in the enzyme. Sulfhydryl reagents, Iodoacetic acid and N-Ethylmaleimide showed marginal inhibitory effect, but p-hydroxymercuribenzoic acid (PCMB) almost completely stopped the enzyme activity. The addition of thiol compounds such as cysteine could reverse the inhibitory effect of heavy metals and PCMB. The results indicate that sulfhydryl groups of radish root β-amylase were essential for the activity although it is not clear whether the sulfhydryl groups were directly involved in catalysis.